The Use of Oxygen in the Treatment of 
Leukmnia and Grave Ancemias, 
BY 
J. M. Da COSTA, M. D., LL. D., 
AND 
E. P. HERSHEY, M. D., 
OF rw 11. AI >K I. I'll lA. 
nton 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
November, IKK9. Extracted from the 
American .Journal of the Mcdu-al Scienceg for Novemlicr, 18R0. 
THE USE OF OXYGEN IN THE TREATMENT OF LEUKEMIA 
AND GRAVE AN/EM I AS. 
J. M. Da M.D., LL.D., 
A Nil 
E. I*. Hershey, M I).. 
or riitLAtTKt.FiTr*. 
The treatment of the more serious forms of blood diseases is still so 
unsatisfactory that any addition to our means of counteracting them is 
deserving of record and careful scrutiny, and we offer these observations 
in the hope that others will be induced to try what we have found to he 
a potent agent. The changes in the blood in the eases observed were 
followed out in every detail, and the conclusions rest, therefore, not on 
impressions, but on actual minute inspection of the blood corpuscles. 
Cask I.—(». It., jet. thirteen, had been subject to attacks of jaundice 
from infancy; the mother states that she believes the child had a number 
of malarial seizures, but was not certain. When first seen (February <r>, 
18HD), the patient was pale, the conjunctiva pearly and somewhat jaun- 
diced. The spleen was enlarged, extending from the eighth rih to four 
finger-breadths below the margin of the ribs. The tumor had been 
noticeable for a year previous. For nearly two years the patient had 
spells of weakness, extending over a jH*ri«xl of three weeks, and at in- 
tervals of two to three months. Occasionally hemorrhages from the 
nose occurred during this time, hut never sufficient to cause alarm. His 
strength gradually failed, and he was discharged from his position as 
cash hoy in a dry goods house, being unable to stand the work. 
When first seen, the hhxxl was examined and found to contain a suf- 
ficient excess of white corpuscles to warrant the diagnosis of splenic 
leukaemia. This view was substantiated by the fact of the white cor- 
puscles steadily increasing in number, while the red diminished. Feb 
raary 5, 1885); The red numbered »,i MM I, tlx* while 1 hi mi 
c.mm,; by May 20th the white corpuscles had increased to 320,000. 
Having been on arsenic sometime previous to his first visit, the patient 
was given Basham’s mixture and three grains of the extract of ergot 
three times daily, without, however, producing any effect upon tin* 
spleen. Galvanism was tried over the splenic region for two months 
without any improvement. Trinitrine was given at the same time, but 
the patient grew weaker under this treatment, and arsenic was again 
resorted to, though without amelioration. 
On June Ist Ik* began to inhale oxygen, and he improved rapidly 
under the treatment. He was given daily from twenty to thirty litres 
of oxygen, which was continued until August sth. At this time the 2 
DA COSTA, HERSHET, TREATMENT OF LEUKEMIA. 
boy returned to work, much better than when he had left it. The blood 
was again examined September 2d, and found to be ho near the normal 
that a count of the white corpuscles was considered unnecessary, the 
red being increased to 4,8.r)0,(M)0, and one white found to about every 
four hundred red. The oxygen treatment was stopped. 
Unfortunately, in this case, the early history could not be accurately 
determined; the mother’s statements being very conflicting. But the 
great improvement spoke for itself-—the boy is now steadily at work, 
and there is reduction even in the size of the spleen. The area of 
dulness begins fully one inch lower and one inch further to the left of 
the median line than when first seen. 
The following ease gives us a clear history; the patient being a man 
of intelligence and one who takes as much interest in the details of his 
case as those attending him : 
Case lI.—S, L., tet. thirty-five; a man largely engaged in mining 
operations. Up to fifteen years of age he had enjoyed good health. 
'I he family history is excellent. In 1869, he lived in lowa on the banks 
of the Mississippi River, a highly miasmatic region. Three* years 
later, at the age of eighteen, he had an attack of malaria ; the case was 
a severe one, lasting over a jieriod of two years, during which time he 
was seldom free from the symptoms of the disease, and never escaped 
longer than one month without being confined to his bed. In 1874, ho 
moved to a district among the Rocky Mountains, where he was entirely 
free from the outbreaks. Two years later, he had typhoid fever widen 
confined him to his house for nine weeks. The convalescence was slow. 
In 1879, he had an attack of erysijielas lasting six weeks; convalescence 
here, too, was slow. Up to this time the patient had never weighed more 
than one hundred and fifty pounds; in the spring of 1880 he began 
rapidly increasing in weight, reaching, in a period of six months, two 
hundred and twenty pounds. 
Although, for two years, at this period of life, the patient claims to 
have been in the best of health, a slight pallor of the skin was always 
present. He enjoyed, however, but two years of absolute freedom from 
ailment; for, in the spring of 1888, while suffering from jaundice, he 
began to lose flesh rapidly; in one month his weight was reduced to 
one hundred and ninety pounds. In the summer of the same year ho 
had hemorrhages from the nose, tin; attacks lasting twenty-one days. 
The hemorrhages occurred daily, and were uncontrollable by any 
means other than plugging the nostrils; large doses of ergot and gallic 
acid were administered. After the hemorrhages ceased, his weight had 
diminished to one hundred and forty-four pounds. 
In the autumn of 1888, a physician in Denver found that the spleen 
was enlarged ; no examination of the blood, however, was made, and he 
was treated for “ague cake.” Soon after this the patient went to Boston, 
where he had another attack of hemorrhage, lasting ten days. Up to 
this time he had gained ten pounds, but was soon reduced to one hundred 
and forty pounds. A trip to Europe was recommended, and there the 
ftatient in four months’ time gained forty-four pounds. After leaving 
Europe he gradually lost weight. No hemorrhages have since occurred. DA COSTA, HKRBHKY, TREATMENT OK LEUKEMIA. 
3 
Since 1883 he had always suffered the inconvenience of an unquench- 
able thirst, the amount of liquids drunk being enormous—us high us 
twenty pitchers of ice water in the twenty-four hours; besides this, he 
imbibed a large amount of champagne, brandy, and other drinks. Con- 
cerning the early habits of the patient, they were anything but favorable 
to the success of any treatment. From the age of eighteen he bad been 
a heavy drinker, though never to intoxication; by his own statement 
he has taken in a day, without any effect other than exhilaration, two 
quarts of brandy, besides beer and wine, lie has always been an invet- 
erate smoker, and even at the present time does not find it easy to smoke 
less than nine cigars a day. Though a s|»ecific history in the case cannot 
be positively asserted as being negative, yet there have never been any 
symptoms of secondary infection. 
Early in September the patient came to Philadelphia for treatment. 
When first seen he suffered from intense thirst and frequent micturition, 
passing largo quantities of water, containing neither albumin nor sugar. 
The spleen was enormous; it passed nearly two inches beyond the umbil- 
icus. There were profuse diarrhoea and great emaciation. Krgotine gr. ij 
t. d. was prescribed, followed by tartrate of iron and potassium, and that 
by the sulphate of iron.* The ergot was continued more or less through- 
out the month of September, and, obeying strict directions, the stimulus 
was reduced to very moderate amounts. During this time the diabetes 
insipidus disappeared, and the patient drank but a pint of water in the 
twenty-four hours; the diarrhoea was arrested. 
September ‘24th. Arsenite of soda, in gr. fa doses, was prescribed. 
Boon after this the patient went of his own accord to Hot Springs. 
Arkansas, but was advised there to return to Philadelphia, bis case 
being considered non-specific. While at the Hot Springs he took the 
iodide of potassium gr. xv, t. d. This was continued until December 9th, 
being stopped on account of gastric irritation. At this time the spleen 
was outlined and found to extend an inch and a half to the right of the 
median line, and to fill completely the left abdominal cavity—from the 
lower border of the seventh rib above to the lower border in a line with 
Poupart’s ligament. The bbssl contained 3,400,000 red and 02,000 
white corpuscles to the c. mm.; haemoglobin 00 per cent. 
There was some improvement under the use of arsenic and Hasham’s 
mixture. Hut January 10th the patient was worse. Arsenite of soda, 
in doses from fa to of a grain, was taken at irregular intervals until 
June 27th, when it was discontinued, and the oxygen treatment begun. 
An examination of tint blood at this time showed that the red cor- 
puscles had diminished to 1,440,000, the leucocytes had increased to 
1,120,000, a proportion of as The patient had been in the 
West throe months previous to this time. When he returns! to Phila- 
delphia it was found that the character of tin* disease had assumed 
a most serious type. His ap|>earancc was striking. The veins of the 
forehead were largely distended, and the capillaries plainly visible in 
many parts of (In; face, most prominent on the nose. The spleen was 
as large; as ever, (he abdomen greatly distended and tense, assuming 
a spherical shape. The knees were shaky ; the feet were swollen, 
the swelling extending up as far as the knees. Shortness of breath 
was produced upon the slightest exertion; he always felt extreme 
fatigue. The spinal column was tender to the touch ; the sitting posture 
produced severe pain in the bones of the ilium. A distinct anaemic 4 
DA COSTA, HKRSHEV, TREATMENT OK LEUKEMIA, 
murmur wu heard over the base of the heart. Profuse watery discharges 
from the bowel* had set in four day* before hi* return, and still con- 
tinued. lie reported that he had been feverish for weeks, his temperature 
at that time (June 26th) being 102.3° ; he was much depressed in spirits, 
ate stated that, having himself made a careful study of the disease, he 
Hew there was not the slightest hope for him. lie was willing and 
anxious that an ex perienced surgeon should attempt to remove the spleen, 
knowing that his cnances were of the very slightest. 
Beside the condition of the blood in regard to the relation of the 
corpuscles, it might be of interest to add that its color was opaque, 
it Mowed freely from the puncture made by the lancet, and coagulated 
very slowly. Microscopically, the red blood-corpuscles were found to he 
widely separated, extremely pale, and at no time formed in rouleaux. 
The leucocytes varied in size and shape; some were small, others of enor- 
mous size, fully the one-five-hundredth of an inch in diameter; many 
were crescent-shaped as well as large, while others were shaiKdess. 
After two days1 inhalations of oxygen, the character of the blood was 
entirely changed ; observed on the glass slide, the large and misshapen 
leucocytes had entirely disappeared, the red corpuscles formed rapidly 
in rouleaux, and the blood showed no abnormal character other than 
the relation of the white and red corpuscles. 
From June 27th to July 3d the patient took nothing beside the 
oxygen, except a mild hypnotic up*n retiring. Ten litres, three times a 
day, were inhaled. The oxygen was perfectly pure, and was allowed to 
pass through water, to prevent dryness of the throat. The effect at the 
end of the week was marked ; the swelling of the feet was scarcely per- 
ceptible; the appetite was good; the bone pains had almost entirely dis- 
appeared ; the temperature had steadily fallen, and the patient walked 
altout with comparative ease. The number of white corpuscles had 
diminished nearly one-half, while the red had gained a million. During 
the second week the patient was given Basham's mixture, hut it did not 
suit him, ami at the end of the week it was discontinued. In the third 
week of the treatment the most marked improvement took place in the 
general condition. The fever disappeared entirely; there was no swell- 
ing of the feet; the prominent veins on the forehead and the capillaries 
visible on the face had almost completely passed from view; the 
appetite increased; there was shortness of breath only on violent 
exertion, and the patient was but little inconvenienced by walking a 
mile. By the end of the fourth week he hail gained nine pounds. 
CIIAKT. 
Temjierature from Wednesday, June 2fl, to July 7, ISHO. Oxygen commenced in the 
morning of July 27th. Tem|>eniture taken 3r. u. After July 7th the thermometer at 
no time registered over 100°. DA COSTA, HBRSHBT, TREATMENT OF LEUKEMIA. 
From this time the improvement was steady until August 20th, when, 
hy some indiscretion in diet, aided greatly by a few bottles of cham- 
pagne, together with the atmosphere of Boston, which did not suit him, 
lie began to fail. The white corpuscles increased in number, the red 
slightly diminished. 
August 26th, ho returned to Philadelphia, since which time he has 
rapidly gained in strength, and is now on a visit in Colorado, having 
stood the trip very well. Not long before he lel\, the spleen was care- 
fully percussed, and presented a marked reduction in size, the transverse 
diameter extending only to three-quarters of an inch of the median line 
near the umbilicus. A telegram from Denver of Septeml>er 20th 
records: spleen going down, blood in excellent condition, htemoglobin 
up, appetite excellent. 
An ophthalmological examination made August 29th, by Dr. Gould, 
showed a noteworthy absence of several of the typical signs of leuca-mic 
retinitis as described by Liebreich, Becker, I/eber, and others. Dr. Gould 
regretted that he had no opportunity to make an examination at an earlier 
stage of the disease when the proportions of the red and white corpuscles 
were so abnormal. There is in both eves a grayish haze that suffuses 
the central part of tin* fundus, especially about the papilla, in semi- 
obscurity. This gradually clears until at about 50° the details of the 
periphery are normally clear. Hut this discoloration is not yellow, nor 
lias it an orange tint. The veins are highly distended and engorged, 
but only slightly tortuous; the arteries of subnormal size, often thread- 
like; the light-streaks of the centre well preserved; the color of the 
blood is pale, hut not excessively so. No white hands of extravasated 
corpuscles follow the vessels, and the white dots or splotches usually 
described are not to bo seen about the macula or jieriphery. and no 
remains of hemorrhages are to be found. The existence of a typical 
tobacco papilla is very noticeable. The visual acuity is good, full 
with either eye, despite a slight hyperopic astigmatism. 
During tho course of treatment the oxygen was stem lily increased to 
sixty litres in the twenty-four hours, and now one hundred litres a day 
are inhaled; tho patient having sent by express nearly a thousand 
gallons to Colorado. It was at first thought hest to administer the 
oxygen so that it he taken at three sittings, this was changed to two 
sittings in the twenty-four hours. Throughout the treatment no unpleas- 
ant symptoms attended the use of the oxygen. An exhilarating effect, 
at least, was looked for, and it was expected that such large doses 
would produce some action upon the heart, hut a sense of freedom felt 
about tho chest after tho inhalation was the only effect noticed. 
During the treatment of these cases of leukaemia, two cases of chlorosis 
were given inhalations of oxygen, as an adjunct to the use of iron. 
These are brief records of them. 
Cask III.—A. M., set. seventeen,school-girl. In the early spring she 
began to feel weak, and suffered considerably from headache. Her 
menses at that time were scant, and disappeared entirely during the 6 
DA COSTA, HKRSHEY, TREATMENT OF LEUKAMIA. 
months of April and May. For six months previous to tins she had 
been pale. On June Bth, the patient was extremely pale, the conjunc- 
tiva; fjearly, there was but little color to the li|>s. The blood was ex- 
amined, and found to contain but 25 per cent, of haemoglobin, the red 
blood-corpuscles numbering 3,800,000 to thee. mm.; white corpuscles 
one to every four hundred and eighty red. The sulphate of iron in 
increasing doses was prescribed, with daily inhalations of from twenty 
to thirty litres of oxygen. In two weeks time there was marked im- 
provement. June 24th the menses reappeared, though scant. 
By July Ist her color had returned. An examination of the blood 
showed the lucmoglohin to 1m; 90 per cent., the red corpuscles numbering 
4,850,000 to the c. mm. White corpuscles one to every six hundred red. 
Case IV.—K. E., let. twenty-three, teacher. Menses irregular and 
want fora number of months. She suffered much from headache. For 
the past three months she has been very pale. There was considerable 
shortness of breath. A large eczematous patch covered most of the 
chin. Examination of the blood showed the lucmoglohin to ho hut 50 
jn;r cent, of the normal, the red corpuscles numbering 6,000,000 and the 
white normal. She was given the sulphate of iron in increasing doses, 
and inhalations of from twenty to thirty litres of oxygen a day. To 
the eczema an ointment of ten grains of resorcine to an ounce of oint- 
ment of oxide of zinc, was applied at night. July 24th, the general 
health was much improved, and the lucmoglohin found to be 45 per cent. 
The iron pills and the oxygen were continued. 
August 2d. Menses were about normal, the lucmoglohin GO per cent. 
The patient was again seen August 28th. She had discontinued the 
oxygen on August Bth, and took no medicine after August 12th, the 
eczematous patch having disappeared. She was still somewhat pale; the 
lucmoglohin was found to be 75 per cent. The pills were renewed, 
oxygen was resumed, and pc|>sinc and hydrochloric acid were taken after 
meals. September Bth, her color was normal and the lucmoglohin found 
to be 90 per cent., the patient feeling strong and hearty. 
Of the value of the oxygen in these severe eases of amemia there can 
be no doubt, though they were of a character in which it is likely that 
other treatment long persisted in would also have been beneficial. But 
certainly a curative effect would not so soon have been accomplished 
without the oxygen. With these results in mind, it is natural that we 
should have been anxiously waiting to observe its effects in a case of 
undoubted pernicious amentia. Such a case is now in our hands, in 
which the first examination showed only 900,000 red corpuscles, and the 
second, in about a week afterward, 700,000; the haemoglobin at both 
being ‘25 per cent. The patient is weak to the verge of utter exhaus- 
tion. We have begun the oxygen treatment, hut have not ns yet used 
it long enough to judge of its merits. 
But to return to what we have been studying in the first group of 
cases—to the leukicmic condition and the changes wrought in it. That 
these were made through altering the blood seems certain. With its 
alteration, the nervous system recovered from its depressions, the mind 
improved, flesh and strength were gained, the secretions became healthier, DA COSTA, HKRSHEY, TREATMENT OF LEUKAMIA. 
7 
and all this took place rapidly, and in cases in which iron and arsenic 
had failed to stay the downward course. The effect on the spleen was 
less evident, for the organ, though decreased, remained very large in 
both. 
It may be of interest to compare the results of the treatment with 
some instances of the disease in which blood counts were made while 
other remedies were employed. In Mr. Barton's well-known case,1 
in which for four months large doses of arsenic were taken, the 
dose reaching twenty-five minims of the liquor arsenicalis six times a 
day, there was a most striking improvement. The white corpuscles 
were greatly reduced, but then* was but little increase in the red. We 
have made blood counts in casi*s treated with phosphorus, and in cases 
treated with arsenic. In one with phosphorus persisted in for three 
weeks in decided doses, two observations on the blood showed no im- 
provement, and the patient was lost sight of. Arsenic we have often 
employed and made frequent examinations of the blood during its use. 
We append one followed to the end, drawn up for convenience’ sake in 
tabular form. 
Tub Cask ok 11. It., Treated mainly by Arsenic. 
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5 
The following shows the line of treatment in the cam.* of H. it.: 
June 12th to July Ist. Quinine sulph. gn«. v, t. d., ext. of ergot. grs. 
v, i. d« 
.July Isi to Sept. 2<»th. Stomach irritable. Krgot discontinued, 1 iq. 
Fowleri iv, increu»e<l gradually to w, t. a., discontinued only 
when stomach became irritable. 
'flio patient died November 29, IMBM. Post-mortem examination; 
Spleen weighed eight pounds, the liver six and a half. Kidneys con- 
tracted. Inflamed condition of the alimentary canal and peritoneum. 
Mesenteric glands enlarged. Fatty and dilated heart. Pleural adhe- 
sions. Slight broncho-pneumonia. Anasarca. 
1 Yrar book of Troalmont, 1889. 8 
DA COSTA, HBRBHET, TREATMENT OF LEUKAEMIA. 
For purposes of comparison we append, at the risk of some repetition, 
the results in tabular form, with reference to the blood and its change 
by the oxygen treatment, in the two cases of leukicmia detailed at the 
beginning of the paper. The increase of red as well as the diminution 
of the white corpuscles is very obvious. 
The Cask of Q. It., showing the Relation of the Red and White 
Corpuscles before and after the Inhalations of Oxygen. 
Number of 
Number of 
Per cent. 
The proportion 
ml corpuncles 
white corpuscles 
of h*mo- 
of red to white 
to the c.mm. 
to the c.mm. 
globln. 
corpuscles. 
Feb. 
6. 1889. 
2,850,000 
105,(MM) 
20 
1 : 22 
April 
10, 
2,860,000 
120,0<K) 
25 
1 : 24 
May 
12, 
2,650,000 
300,(MM) 
20 
I : 8 
14 
20, 
2.550,000 
320,(MM) 
15 
1: 8 
June 
10, 
3,000,000 
165,000 
20 
1 : 12 
it 
23, 
2,675,000 
160,(MM) 
— 
1 : 16 
it 
28. 
3,500,000 
17,500 
— 
1 : 200 
July 
5. 
3,800,000 
17,277 
30 
1 : 220 
tt 
10, 
4,000,000 
10,650 
— 
1 : 880 
tt 
16, 
4,300,000 
13,300 
45 
1 : 828 
it 
29, 
4,520,000 
14,000 
65 
1 : 323 
Sept. 
1. 
4,850.000 
— 
— 
1 : 400 
The following shows the line of treatment in the case of G. B.: 
February sth to ‘23d. Basham's mix. sbb, t. d.; ext. of ergot, grs. iij, 
t. <l. 
Jj JFebruary 23d to May 25th. Trinitrine gtt. i-v, t. d.; quinine grs. 
iij, t. d.; galvanism. 
June Ist to .July 29th. From 20 to 30 litres of oxygen a day; no 
other treatment. 
During the month of August the sulphate of iron was prescribed. 
The Case of S. L., showing the Relation of the Red and White 
Corpuscles before and after the Inhalations of Oxygen. 
Number of 
Number of 
Per cent. 
The proportion 
red corpnaclee 
while corpnaclee 
of h*ino- 
of red to white 
to the c.mnu 
to the c.mm. 
Klobln. 
corpuaclea. 
Dec. 
9, 1888. 
8,600,000 
imhi 
70 
1 : .... 
Jan. 
5. 1889. 
3.200,000 
200,000 
60 
1 : 16 
Feb. 
5. 
2.600.000 
450,000 
45 
1 : 61 
June 
26. 
1,440,000 
1,120,000 
25 
1: U 
July 
8. 
2. |08. 
684.000 
36 
1: 4J 
i# 
10. 
2,140,000 
560,000 
85 
1 : 4 
II 
17. 
2.292,000 
.‘158,000 
40 
1 : 64 
II 
24, 
2,484,000 
320,000 
— 
1 : 8 
II 
81. 
2,792,680 
167,320 
— 
1 : 17+ 
Aug. 
18. 
4,614,200 
165,800 
60 
1 : 30 
27. 
3,440,000 
320,000 
— 
1 : 14 
Sept. 
1, 
4.658,000 
142,000 
65 
1 : 32+ 
The following is the treatment carried out in the case of H. L.: 
Dec. 9, 1888, to Jan. />, 1889. Potassium iod. grs. xv, t. <l.; sulphate 
of iron. DA COSTA, lIERSFIKY, TREATMENT OF LEUKEMIA. 
9 
Jan. 10th to June 20th. Arscnite of soda gr. jV-aV t* d.; iron dis- 
continued. 
June 27th to July 3d. 30 litres oxygen daily. 
.1 uly 3d to 10th. 45 litres oxvgen daily; Basham’s mix. t. d. 
July 10th to Aug. 14th. 54 litres oxygen daily. 
Aug. 14th to 22d. 54 litres oxygen daily ; sod. arscnite gr, t. d. 
Aug. 22d to Sept. Ist. (>0 litres oxygen daily ; arsenic discontinued. 
After Sept. Ist. 100 litres oxygen daily. 
We are not aware that oxygen has been systematically used in serious 
blood affections. The only cast' of its employ we can find recorded 
is the one of leukoomia reported by Slicker.1 The examination of blood 
showed the red corpuscles decreased to 30 j»er cent., the white corpuscles 
numbering 3,736,000; a proportion of white to red of 1:0.6. From 
May sth to August 22d the patient took daily inhalations of oxygen, 
commencing with thirty litres, which was finally increased to sixty 
litres a day. August 22d the red corpuscles numbered 4,400,000, the 
white 33,200 ; the patient, after a relapse in which the administration 
of oxygen had no effect, died the following January. 
The mode of action of oxygen is not fully known. We have here a 
field in which the therapeutic powers of this gas may be, by continued 
observation, ascertained. Sticker has suggested that the white corpuscles 
absorb oxygen, and use it up in tbe blood, and this at the exjiense of 
the red corpuscles, and that the administration of the gas might Ik* 
expected to restore the; normal condition, as well as to aid in the conver- 
sion of white into red corpuscles. 
In all cases of leukiumia then* is always found an impairment of some 
one or more of the blood-making organs, due at times to a known cause, 
at others to an unknown one. In Cast* 11. the history is that of decided 
disease of the spleen, long before the blood became markedly affected. 
It was not until the functioning power of the spleen was seriously dimin- 
ished that the blood gave signs of leukaemia, and as it became more and 
more impaired by the overgrowth and distention of the diseased organ, 
the red corpuscles diminished and the white increased. We had then, 
it seems, in the action of oxygen, a substitution for the function of the 
spleen. We did in both these cases, artificially, what the damaged organ 
could not perform—we allowed the metamorphosis of the white corpus- 
cles into red to go on. The hope in benefiting the patient is to keep up 
this substitution until the lesion is influenced by the improved nutrition, 
aided by other means ; or, in appropriate coses, until the system is so 
far built up to make surgical interference a procedure much more likely 
to succeed than it does now. Whether permanent effects follow this 
1 Heitrilge zur I'lithologi* umi Therspie der Leukirmia. ZciUchr. f. klin. M«d., Bd. 
14, Heft, I, 2, IfIHH, 10 
DA COSTA, HKBSHEY, TREATMENT OF LEUKEMIA. 
oxygen treatment, or mere temporary benefit and prolongation of life, 
we cannot as yet say. In cases in which the structural changes are still 
slight, we believe the remedy may bring about a permanent change; in 
more advanced cases this is more doubtful. But, under any circum- 
stances, that it prolongs life and produces results not to be otherwise 
obtained, our experience enables us to affirm. THE AMERICAN JOURNAL 
OF THE MEDICAL SCIENCES. 
TljflTH the first issue for 1890, The American Journal of the Medical 
Ijrl Sciences enters upon its seventieth year, still the leader of American medical 
periodicals. In its long career it has developed to perfection the features of 
usefulness in its department of literature, and presents them in unrivalled 
attractiveness. It is the medium chosen by the leading minds of the profession on both 
sides of the Atlantic for the presentation of elaborate Original Articles; its Reviews are 
noted for discernment and absolute candor, and its Classified Summaries of Progress 
present, each month, an epitome of medical advances gleaned by specialists in the 
various departments. According to unquestionable authority, “It contains many original 
papers of the highest value; nearly all the real criticisms and reviews which we possess; 
and such carefully prepared summaries of the progress of medical science and notices 
of foreign works, that from this file alone, were all other publications of the press for the 
last fifty years destroyed, it would be possible to reproduce the great majority of the real 
contributions of the world to medical science during that period.” Published monthly. 
$4.00 per annum. 
Medical . 
With the beginning of the New Year the features of The Medical News as a 
newspaper will lie largely developed. The province of a weekly medical periodical lies 
in furnishing its readers with prompt and condensed information relating to advances in 
all departments of medicine; and to this end. long and elaborate articles will not appear 
in The News. Only such material will be presented in The News as is thoroughly 
practical, and by judicious condensation ample space will be found to make every 
number one of interest and importance to every reader, whether general practitioner 
or specialist. Several new departments will be added, namely: Clinical Memoranda, 
Therapeutical Notes, Hospital Notes and Special Articles, giving opportunity for the 
presentation of much therapeutical and practical information in the briefest possible form. 
Necessarily different in their spheres, The American Journal ok the Medical 
Sciences and The Medical News arc mutually supplementary, and every reader of 
both periodicals may feel assured that nothing in the life of the great medical world will 
escape his attention. 
The of Treatment for 18SQ 
Gives a classified statement of the value and uses of all remedies which have been 
introduced and practically tested during the year. Price, $1.25; or in combination with 
either or both the above journals, 75 cents. 
file Medical Relate Visiting List for 12Q0 
Contains 48 pages of indispensable practical information and data and 176 blank pages, 
ruled to accommodate all records of practice. Handsomely bound in red seal, f1i.25. 
In combination with either or both above periodicals, 75 rents. Thumb-letter Index, 
for quick use, 25 cents extra. 
LEA BROTHERS A CO.. PUBLISHERS. PHILADELPHIA. 706 A 708 SANSOM STREET.